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Management of neurotrophic keratopathy

Lambiase, Alessandro MD*†; Rama, Paolo MD; Aloe, Luigi PhD§; Bonini, Stefano MD*†

Current Opinion in Opthalmology: August 1999 - Volume 10 - Issue 4 - p 270-276
Corneal and external disorders and refractive surgery
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Neurotrophic keratopathy is a degenerative corneal disease caused by an impairment of corneal sensitivity. Lack of the sensory nerve's trophic effect is responsible for the impairment in corneal healing and for the changes on the ocular surface that lead to corneal epithelial deficit, ulcer, and perforation. The etiology and recent advances in understanding of the pathogenetic mechanisms of neurotrophic keratopathy are reviewed here. An accurate history and a clinical examination that covers the function of cranial nerves often identify the cause of the disease. Clinical features and guidelines for the differential diagnosis and treatment are presented. Specific medical and surgical treatments, selected on the basis of clinical staging of the disease, can often halt disease progression. Future developments in medical treatment, including the use of neuropeptide and growth factors, are discussed. The identification of corneal anesthesia associated with an epithelial defect allows appropriate treatment and prevention of progression to stromal lysis and perforation.

*Department of Ophthalmology, University of Rome “Tor Vergata,” Rome, Italy; G.B. Bietti Eye Foundation, Rome, Italy; Division of Ophthalmology, Hospital of Venice “SS. Giovanni e Paolo,” Venice, Italy; §Institute of Neurobiology, National Research Council, Rome, Italy

Correspondence to A. Lambiase, Department of Ophthalmology, University of Rome “Tor Vergata,” Via delle Robinie 43, 00172 Rome, Italy; e-mail: llambiase@pelagus.it

© 1999 Lippincott Williams & Wilkins, Inc.